Woman Survives Esophageal Cancer and Wins Gift of a Lifetime

Morgan Hartman and her then-fiancé Phillip de Amezola were busy moving into their new home they bought in 2020 when they realized all of the house’s pipes needed to be replaced. It was the first of several unwelcome developments for the Miami couple, who had been planning on getting married once their lives settled down and their busy schedules permitted.

A short time later, the licensed mental health counselor received a surprise cancer diagnosis and was told she would need surgery to replace one of her own pipes. She had cancer of the esophagus, the hollow, muscular tube that moves food and liquid from the throat to the stomach.

(Watch now: Morgan Hartman recalls how thoracic surgeon John DeRosimo, M.D., and other experts at Baptist Health Miami Cancer Institute helped cure her rare form of esophageal cancer, enabling her to finally move forward with her long-delayed wedding, which became a story in itself. Video by Michael Justiz.)

“Around the same time that we were getting settled into our house, I started having some difficulty swallowing. I love to eat baby carrots but it would just get stuck so I would either have to swallow it or spit it out and try again,” recalls Ms. Hartman, now 52. “I didn’t think much of it and just shook it off. I was too busy getting settled in the house. We had to replace our pipes and there were a number of other things going on.”

Ms. Hartman says she also had a persistent cough that would not go away. “I was taking cough drops throughout the day, cough syrup at night and in the morning. It just never occurred to me that there was something serious going on, though.”

Endoscopy reveals cancerous mass

Later that year, a friend who works as a gastroenterology nurse told her she should get her symptoms checked out. Although she had sought care for her condition previously and was told she had gastric reflux disease, Ms. Hartman had not had any imaging studies done. Fortunately, she heeded her friend’s advice and the week before Christmas she had an endoscopy.

“I had never had acid reflux problems and I didn’t understand why I would have them now,” Ms. Hartman says. “But the gastric reflux medications I had been prescribed weren’t helping so I went to the endoscopy, not really thinking anything about it.”

When she awoke from her anesthesia after the procedure, the doctor was sitting next to her. She told Ms. Hartman she had found a “really large mass” on her esophagus. “I’ve done a lot of these, and even though we’re waiting for your biopsy results, I’m pretty sure it’s cancer,” she told her. The news hit her like a punch in the stomach. “I did NOT see that coming,” she says.

Risk of asphyxiation while eating

According to the National Cancer Institute (NCI), the wall of the esophagus “is made up of several layers of tissue, including mucous membrane, muscle, and connective tissue.” Esophageal cancer “starts on the inside lining of the esophagus and spreads outward through the other layers as it grows.” Men have a higher rate of esophageal cancer than women, the NCI says.

To avoid the potential for asphyxiating on food, Ms. Hartman’s doctor prescribed an all-liquid diet until she could be seen by a cancer specialist. She was not happy with the prospect. “The holidays were coming – Christmas, New Year’s – and I was on an all-liquid diet so that I wouldn’t choke,” Ms. Hartman says.

Adding to her stress was a delay in getting her biopsy results back. “Because of the holidays, we had to wait longer for my biopsy results.” It wasn’t until January 4^th that her doctor called and confirmed that she did indeed have esophageal cancer. She was referred to John DeRosimo, M.D., a thoracic surgeon at Baptist Health Miami Cancer Institute.

A rare and aggressive cancer

Dr. DeRosimo confirmed Ms. Hartman’s cancer diagnosis but stressed that although her cancer was rare, her curative chances were very high.

John DeRosimo, M.D., thoracic surgeon at Baptist Health Miami Cancer Institute

“There are two main types of esophageal cancer, the most common of which is adenocarcinoma that’s usually found in the bottom of the esophagus, closer to the stomach,” he says. “Adenocarcinomas are usually associated with reflux disease, where there are changes because of the exposure to stomach acid that leads first to inflammation and then dysplasia, or abnormal growth, and eventually cancer.”

The other main type of esophageal cancer is a squamous cell carcinoma, Dr. DeRosimo says. “This is more commonly found in the upper or mid-esophagus, and is most often associated with tobacco use and alcohol.” Ms. Hartman had neither of these, however.

“Ms. Hartman had a sarcomatoid carcinoma, a rare and aggressive cancer,” says Dr. DeRosimo. “These account for about only about one percent of all esophageal cancers, and there are no known risk factors for this type of cancer.”

Before going any further, Dr. DeRosimo referred Ms. Hartman to his colleague Antonio Ucar, M.D., an oncologist/hematologist at Miami Cancer Institute. He also submitted her case for review by the multi-disciplinary panel of specialists on the Institute’s Tumor Board so they could offer their recommendations on the best approach for treating her cancer.

Antonio Ucar, M.D., oncologist/hematologist at Baptist Health Miami Cancer Institute

Using the stomach to replace the esophagus

As part of her induction therapy, which Dr. DeRosimo says aims to improve surgical outcomes by reducing the burden of cancer before surgery, Ms. Hartman underwent five sessions of chemotherapy and 28 sessions of radiation therapy. By April 2021, she had recovered from these treatments and Dr. DeRosimo was able to perform a robotic three-field esophagectomy, more commonly called gastric pull-up surgery.

The intricate surgery entailed removing the diseased esophagus and then pulling up stomach tissue to create an all-new esophagus. In the robotic, minimally invasive procedure, Dr. DeRosimo removed Ms. Hartman’s esophagus along with all of the surrounding lymph nodes and the top portion of her stomach.

Once that part was done, he took the remaining portion of Ms. Hartman’s stomach and turned it into a tube that he pulled all the way up to the base of her neck. “We then connected the remnant of her esophagus in the neck to the tube of the stomach so that her entire gastrointestinal tract was intact and there would be a way for her to eat after surgery.”

After recovering in the hospital for nine days, Ms. Hartman was sent home, still on a liquid diet and eventually graduating to solid food. Six weeks later, for her 50^th birthday, “I could only have small bites of ice cream and half a muffin,” she says, adding that even today she can eat only a small amount at a time before feeling full. “There’s nothing I can’t eat today, though. That’s the good news.”

Ms. Hartman did very well with surgery, according to Dr. DeRosimo. “Two and a half years have passed since her diagnosis and treatment and she is cancer-free,” he says. “She is eating a regular diet and doing very well. I expect that she can look forward to a long, healthy life.”

Robotic surgery and new therapies benefit patients

Robotic surgery has benefitted patients and surgeons alike, Dr. DeRosimo says. “The patient’s recovery is easier. They have less inflammation, less pain, and a quicker return of their gastrointestinal function after surgery,” he points out.

Compared to open surgery, robotic surgery also offers the surgeon greater magnification, precision and control, Dr. DeRosimo says. “Instead of having to make large cuts in the chest and the abdomen, we’re essentially using small holes to operate. I’m using the robot as if it were my little hands going inside the patient.”

Dr. DeRosimo says that improvements in chemotherapy and especially immunotherapy in the treatment of esophageal cancer, lung cancer and other cancers have also made a dramatic impact in the overall survival and management of these patients.

Acid reflux a risk factor for esophageal cancer

The survivability of esophageal cancer all depends on what stage it is when diagnosed, he notes. “For those who present with an early-stage tumor, most of them will have up to a 90 percent chance of being alive five years after surgery. That’s a very high survival rate.”

The biggest risk factor for esophageal cancer, Dr. DeRosimo says, is gastroesophageal reflux disease (GERD), more commonly known as acid reflux, which happens when stomach acid repeatedly flows back into the esophagus. 

“For patients with long-standing reflux, it’s probably a good idea to see your gastroenterologist, and if appropriate, undergo an upper endoscopy to evaluate whether or not you’re having any changes associated with the lining of your esophagus,” he advises. “If they see any changes, you need to be followed and screened on a regular basis so that, if a cancer does develop, it’s caught early.”

A healthy outlook on life

Dr. DeRosimo says that Ms. Hartman has a great approach to her health and would be “a great role model” for others facing a cancer diagnosis. “She has a very good attitude about overcoming the obstacles in her path with this diagnosis and the disease treatment process,” he says. “She has a very healthy outlook on life. And I am encouraged that she’s going to continue to do well.”

After receiving her diagnosis in 2020, Ms. Hartman wrote in her diary: “I don’t know what 2021 will bring for me, but I know I don’t plan to face it with fear, anger, worry or blame. I’m planning to greet it with courage, hope & faith. I’m going to love my body & treat it kindly and thank it for showing up each day for whatever it needs to do. I’m going to choose gratitude over complaints. I truly hope everyone has a wonderful 2021 - me included!”

The gift of a lifetime

Although life has brought a few more unwelcome developments for Ms. Hartman over the past year or so – including a serious bowel obstruction that defied detection for months and a close call for her husband, who recently underwent emergency surgery at Baptist Health Baptist Hospital for a life-threatening abdominal aortic aneurysm – it has also brought much happiness.

After postponing their planned wedding because of her cancer treatment and his health scare, among other things, Ms. Hartman and Mr. de Amezola were the lucky winners of the “Gift of a Lifetime,” a contest sponsored by the Ritz Carlton Key Biscayne and Miami Cancer Institute.

Their prize? An all-inclusive wedding at the resort hotel this past October with 50 family and friends, including a complimentary bridal dress, groom’s tux, wedding planner and lavish reception. Stories of the couple’s wedding – and the challenges they faced leading up to it – appeared soon after in the New York Times and numerous other local and national media.

Feeling safe, supported and grateful

Ms. Hartman says she was fortunate to have such a great care team at Miami Cancer Institute. She calls Dr. DeRosimo “an amazing and intuitive surgeon” and says Dr. Ucar is “very steady and very calm.” Her radiation oncologist, Michael Chuong, M.D., vice chair and medical director of radiation oncology at Miami Cancer Institute, was also an important part of her care team.

“Dr. Chuong would show me pictures of the scan after each session and I was able to see my tumor getting smaller,” Ms. Hartman says. “Even though my pain was getting worse, I could see that that treatment was working.”

She says that, for her, being alive today is “the gift of a lifetime” and she is “beyond grateful” for the fact that she had a cancer that was highly curative and that she responded so well to her treatments. “I didn’t do anything special other than have a good attitude and suit up and show up,” says Ms. Hartman.

She adds that she can’t say enough good things about the people she has met at Miami Cancer Institute and for the healing hands and the support she had there. “This place saved my life,” Ms. Hartman says. “To this day, every time I walk in these rooms, these halls, I feel safe. I feel supported.”